Indian Journal of Ophthalmology

ARTICLES
Year
: 1985  |  Volume : 33  |  Issue : 4  |  Page : 233--237

Clinical evaluation of nonsteroidal antiinflammatory drugs in postoperative inflammation following cataract surgery


MH Shaikh, KJ Sheth 
 Department of Ophthalmology, Medical College, Baroda, India

Correspondence Address:
M H Shaikh
Department of Ophthalmology, Medical College, Baroda
India




How to cite this article:
Shaikh M H, Sheth K J. Clinical evaluation of nonsteroidal antiinflammatory drugs in postoperative inflammation following cataract surgery.Indian J Ophthalmol 1985;33:233-237


How to cite this URL:
Shaikh M H, Sheth K J. Clinical evaluation of nonsteroidal antiinflammatory drugs in postoperative inflammation following cataract surgery. Indian J Ophthalmol [serial online] 1985 [cited 2021 Sep 20 ];33:233-237
Available from: https://www.ijo.in/text.asp?1985/33/4/233/30798


Full Text

As an anti-inflammatory agent, though, steroids are powerful fey the geed, they are also potent for evil. The relative clinical effi­cacy of various nonsteroidal anti-inflamma­tory drugs (NSAID) with regard to intraocu­lar inflammation has not been however widely assessed. The present controlled clinical study was therefore carried out to assess the efficacy of orally administered NSAID namely oxyphenbutazone, indomethacin and ibupro­fen in post-operative inflammation following cataract surgery and to assess their compara­tive value as an alternative to time honoured steroid prednisolone.

 MATERIAL AND METHODS



After careful check up to exclude any local and systemic disease, the patients having uncomplicated senile cortical cataract were considered for the admission to this study. The patients were randomly assigned to one of the following groups:

The drugs were started a day before ope­ration and continued in 1 hourly schedule for a total period of 6 days. Postoperatively the local dressing was carried out with chlo­romycetin ointment and homatropine drops 2% daily. No steroids were topically applied till 5th postoperative day.

Uniform surgical technique was maintain­ed by different operators. The patients who underwent uncomplicated intracapsular cata­ract extraction were considered eligible for the final analysis.

In addition to cases with operative com­plications, the patients who developed any local or systemic complications postoperati­vely were further excluded from analysis.

Pain, Photophobia, Lid Swelling, Con­juctival Congestion, Conjuctival Edema, Circumcorneal Congestion, Striate Keratitis and Aqueous Flare were assessed daily. The pigment dispersion was assessed on fifth day.

Based upon the underlying pathophysio­logic mechanisms, each parameter was asses­sed in 0 to 3 severity scale (Grade-0 Nil, Grade-1 Mild Severity, Grade-2 Moderate, Grade 3 severe) and scored accordingly[1].

 OBSERVATIONS



Out of 117 patients which entered the study, 100 patients fulfilled criteria. There were 20 patients in each group.

 COMPARISON OF DRUG TREATED WITH CONTROL GROUP



By preoperative administration of drugs we could achieve significant beneficial anti­inflammatory effects on each of the parame­ters assessed right on first post-operative day. This holds true for prednisolone as well as NSAID [Table 1]. With continued adminis­tration of the drugs resolution of the infla­mmation occurred at considerably faster rate in comparision to control group. There is more than 80% reduction of average grand total score in drug treated groups while this amounts to just 45% in control group [Table 2].

 NSAID V/S PREDNISOLONE



Not even on a single parameter could pre­dnisolone show antinflammatory efficacy superior to any of the NSAIDs studied. NSAID show superior analogesic effect in early postoperative period compared to prednisolone. Superior efficacy of NSAID on various parameters is evident from [Table 1].

Overall evaluation shows that both oxy­phenbutazone and ibuprofen are significantly better than prednisolone as regards their early efficacy observed on 1st day as well as total efficacy achieved by the 5th day. [Table 2]. Indomethacin group patients have lower average grand total scorecompared to predni­solone throughout the ovservation period, the difference however is statistically not signifi­cant.

 COMPARISON AMONG NSAID



Among nonsteroidal drugs, both Ibupro­fen and oxyphenbutazone were found to be better than indomethacin as suggested by overall evaluation. [Table 1]. -Ibuprofen group patients have lower average total symptoms and signs score than those receiving oxyphen­butazone, the difference ish owever statisti­cally not significant. The graphical presenta­tion of average total symptom and sign score once again reveals that Ibuprofen is most effective followed by oxyphenbutzone, indo­methacin and prednisolone in that order.

As seen from [Table 1], nonsteroidal have exerted antiinflammatory activity of varying intensity on various parameters.

 DAYS OF HOSPITALIZATION



The earliest day by which none of the parameters had score exceeding one was recorded. In comparison to control group, drug treated patients could be discharged earlier from hospital.

 OTHER OBSERVATIONS



There were not a single case of filtering bleb resulting from would leakage in any of the groups attributable to better would closure with multiple corneo-scleral stitches.

 SIDE EFFECTS



There were no severe side effects necessita­ting drug withdrawal. Ibuprofen group was totally free of GIT side effects.

 DISCUSSION



Pretreatment of animal models and human subjects with NSAID have been shown to prevent the disruption of blood aqueous barrier occurringin response to trauma by pre­venting[3],[4],[5] the synthesis and release of prost­aglandlins. It should be noted that similar stabilization of blood aqueous barrier with pre-treatment with steroids is not definitely demonstrated[2].

Whatever be the underlying mechanisms, the fact of immense clinical importance is that the preoperative institution of antiinflam­matory therepy is wiser and more logical policy than starting the therepy after the struc­ture of eye have already been damaged following an exposure to deleterious effects of inflammatory mediators which are invariably released in response to an operative trauma.

Overall superiority of nonsteroidal drugs in suppressing inflammation over predniso­lone could be related to property of inhibition of PG synthesis by former class of drugs as a group.

Considering the relative safety of Ibupro­fen as regards gastrointenstinal, cardiovascu­lar and haematological toxicity, it emerges to be the NSAID of the choice from our study. Agarwal et al (1982) found overall superi­ority of oxyphenbutazone (600 mg/day) over Ibuprofen (600 mg/day) and also over pred­nisolone (20 mg/day). In our study we used the oxyphenbutazone in just the half dosage (300 mg/day) and still we could obtain effects better than prednisolone which was used in the dose as high as 30 mg/day. The vital con­sideration therefore is that by reducing the dose of oxyphenbutazone, we could reduce the chances of toxic effects which, in the case of oxyphenbutazone are directly dose related. The reduction of dose also means better patient compliance. Further, by using Ibupro­fen in dosage of 1200 mg/day, we obtained significant anti-inflammatory effects without having invited extra toxicity.

Ocular penetrability of a drug is critical for the clinical effects. Relatively poor effi­cacy of indomethacin could be explained if it is remembered that the drug penetrates the eye poorly and is transported out of the eye actively.

Variable effects of NSAID on various parameters can be explained if one remembers that the one of the most characteristic feature of PG synthetase system is that while it seems to be quantitatively similar in different tissues it exhibits profound quantitative differences as regards its inhibition by NSAIDS.[6]

With the use of anti-inflammatory therapy, patients could be discharged at an earlier date. This is of special interest in India where seve­ral patients are waiting for their turn of cata­ract extraction, reduction of days of hospita­lization, means a lot.

 SUMMARY



A controlled clinical trial to evaluate effi­cacy of various antiinflammatory drugs admi­nistered orally rvealed the importance of starting therapy preoperatively. Ibuprofen and oxyphebutazone showed markedly superior efficacy in comparison to prednisolone and indomethacin. The use of nonsteroidal drugs is free from serious local and systemic side-effects. Considering higher efficacy and total freedom from side effects Ibuprofen (1200 mg/day) emerges to be the drug of choice[7].

References

1Hogan, M. J.. 1959, Amer. J. Ophthalmol. 4-47; 155.
2Leopold, I. H., 1974, Symposium on ocular therapy, The C. V. Mosby Company, Saint Louis, P. 96.
3Bhattacharjee, P., Eakins, E. K., 1975, Pros­taglandians, 9 ; 197.
4Zimmerman, T. J. Gravenstein, N., 1951, Amer. J. Ophthalmol 34: 945.
5Mathur, S. K., Satsangi, U. K., 1981, Ind. J. Ophthalmol, 29 :96
6Horribon, D.F.. 1974. Prostaglandians, Chur­chill Livingstone, Edinburg.
7Agrawal, R. L... Lodhan. C. K., 1982, Ind. J. Ophthalmol, 30: 463.